Читать книгу Treatment of Oral Diseases - George Laskaris - Страница 33

Chronic Ulcerative Stomatitis

Definition

Chronic ulcerative stomatitis is a newly described, rare oral disease with characteristic immunofluorescent findings.

Etiology

Chronic ulcerative stomatitis is an autoimmune disease with characteristic specific antinuclear antibodies directed against stratified epithelium.

Main Clinical Features

The disease involves, almost exclusively, the oral mucosa and has a chronic course with recurrences.

Oral Mucosa

•Gingival lesions usually appear in the form of desquamative gingivitis

•Oral mucosal lesions (buccal mucosa and tongue) appear as painful erosions or ulcers, usually associated with white reticular lesions identical to those seen in oral lichen planus

Diagnosis

The clinical diagnosis should be confirmed by histopathologic examination and particularly by direct and indirect immunofluorescent tests.

Differential Diagnosis

•Lichen planus

•Discoid lupus erythematosus

•Cicatricial pemphigoid

•Linear IgA disease

•Bullous pemphigoid

•Epidermolysis bullosa acquisita

•Pemphigus

•Oral psoriasis

•Idiopathic form of desquamative gingivitis

Treatment

Basic Guidelines

•Patients with gingival involvement should avoid the use of hard toothbrushes or any mechanical friction.

•Systemic or local treatment may be used depending on the severity of the disease.

•Recurrence may occur after cessation of treatment.

Suggested Therapies

Systemic Treatment

Hydroxychloroquine

Hydroxychloroquine (Plaquenil) 200-300 mg/day is the treatment of choice for chronic ulcerative stomatitis. The lesions usually respond to treatment in 1-2 weeks and may disappear in about a month.

Oral Corticosteroids

Prednisone or prednisolone 20-40 mg/day reduce the symptoms and lesions heal in approximately 2-4 weeks. Then the dose is tapered slowly by 20% every 2 weeks. Topical corticosteroids may be used to maintain the results.

Topical Treatment

The use of 0.1 % triamcinolone acetonide in an oral adhesive base (Orabase), fluocinolone acetonide in an oral paste or 0.05% clobetasol propionate gel either alone (in mild lesions) or after control of severe lesions by systemic treatment is usually effective, particularly in cases of desquamative gingivitis. Intralesional injections of triamcinolone acetonide for extragingival lesions is also helpful.

References

Chorzelski TP, Olszewska M, Jarzabek-Chorzelska M, Jab-lonska S. Is chronic ulcerative stomaiitis an entity? Clinical and immunological findings in 18 cases. Eur J Dermatol 1998;8:261–265.

Jaremko WM, Beutner EH, Kumar V, et al. Chronic ulcerative stomatitis associated with a specific immunologic marker. J Am Acad Dermatol 1990;22:215–220.

Lewis JE, Beutner EH, Rostami R. Chorzelski TP. Chronic ulcerative stomatitis with stratified epithelium-specific antinuclear antibodies. Int J Dermatol 1996;35:272–275.

Worle B, Wollenberg A, Schaller M, et al. Chronic ulcerative stomatitis. Br J Dermatol 1997;137:262–265.